CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Cass County Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $746
Cash Discount Price: $1,231
vs. Medicare Baseline: 6.98x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Cass County Memorial Hospital is $746. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,231. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.98x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$1,231

Average discount available for prompt cash payment at this facility.

Insurance Median

$746

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,231 (1153%)

Insurance Median: $746 (698%)

Cash: $1,231 (1153% of Medicare)

Ins. Median: $746 (698% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 698% of the Medicare baseline (a markup of 598%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$151 - $739	141%
Wellmark Hmo	$329	308%
Midlands Choice Medica Mcr	$352	330%
Wellmark Ppo - All Other Plans	$362	339%
Triwest - All Plans	$717	671%
Aetna	$739 - $1,671	692%
Amerigroup Mcr Adv - All Other Plans	$739	692%
Medica Mcr Adv	$739	692%
Tricare	$739	692%
Va Ccn - All Plans	$739	692%
Wellmark Mcr Adv	$746	698%
Iowa Total Care Mcaid	$754	706%
Iowa Total Care Mcr	$754	706%
Molina Mcaid - All Plans	$754	706%
American Hlth Mcr Adv - All Plans	$761	712%
Medicaid / KanCare	$761	712%
Iowa Total Care Comm - All Other Plans	$813	761%
Midlands Choice New Bus	$1,143	1070%
Medica Comm - All Other Plans	$1,548	1449%
Midlands Choice Pho (Ppo) - All Other Plans	$1,583	1482%
Multiplan - All Plans	$1,671	1564%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,231.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Cass County Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.